Professor Xan Johnson on Autism study

2 Oct , 2017

Harrison Bryan, left, as Christopher Boone and Michael Rudko as Voice Four in Pioneer Theatre Company’s “The Curious Incident of the Dog in the Night-Time.” Brent Ubert

Professor Xan Johnson is in the process of launching a theatre-based intervention program for the development social communication skills, theory of mind skills, and drama skills in preschoolers with Autism Spectrum Disorder.

Social skill deficit is a hallmark feature of autism spectrum disorder (ASD) that contributes to significant disability. An effective intervention fostering generalizable social skill development in children with ASD remains elusive.

Children and adolescents with autism have a surplus of synapses in the brain, and this excess is due to a slowdown in a normal brain “pruning” process during development, according to a study by neuroscientists at Columbia University Medical Center (CUMC). The over-pruning hypothesis proposes that social skill impairments, among others, derive from an aberrant neural pruning process that occurs during early childhood.

As pruning targets weak neural connections and experience strengthens connections, interventions occurring just before critical pruning periods in the neural areas supporting targeted skills should be most effective. Peak synaptic number in areas involved in social skills occurs between age 3 and 5, just prior to pruning, which potentially make it a time most optimal for intervention.

The intervention proposes that theatre programs may offer an effective intervention to foster social skill development in this population. Theatre may be a particularly effective medium due to its ability to create specific learning experiences in a manner that provides embodied cognition and emotional experiences without conscious commitment to abstract social skill improvement goals. The scenes can be tailored to emphasize social and emotional cues and explicit identification of scene-related feelings for the formation of social cognitive and emotional memories that can be recalled as the basis for later social functioning.

However, children with ASD have unique needs surrounding communication, cognition and sensory processing. While theatre teachers are not typically trained to address these problems, speech language pathologists and occupational therapists are adept at addressing those issues. Therefore, the intervention hypothesizes that an interdisciplinary theatre program that combines creative process drama, story dramatization, play devising, and other children’s theatre techniques adapted using speech language pathology, and occupational therapy techniques provided to children with ASD who are between the ages of 3 and 5 will enhance the social skills in this population.

SALT LAKE CITY — Researchers and scientists preparing to conduct a study are accustomed to reading existing literature, finding a pool of test subjects, applying for funding and filling out approval paperwork.

But for a team of researchers at the University of Utah, their preparation process also included a night out at the theater.

Xan Johnson, head of the University of Utah’s theater teaching program, is in the process of launching a study with a team of researchers involved in occupational therapy, communication studies, psychology and brain imaging to determine how providing early exposure to drama classes can benefit children with autism in the long run.

The group is currently looking for participants for the study, and as they prepare to move into the next phase of the project, Johnson had the idea to attend a production of Pioneer Theatre Company’s “The Curious Incident of the Dog in the Night-Time,” which runs through Sept. 30 and follows the experiences of an autistic boy.

“It was very important for me to take my research team (to the play), who are not theater people per se, and they were deeply moved,” Johnson said in an interview with the Deseret News. “I said to Chris Lino (PTC’s managing director) as I was walking out, ‘The scientists cried.’”

In the play, which is based on the novel by Mark Haddon, actor Harrison Bryan plays 15-year-old Christopher Boone, who is autistic and struggles in social situations but has a great talent for math. When Christopher is wrongfully accused of killing his neighbor’s dog, he embarks on a quest to figure out what actually happened to the dog.

Harrison Bryan, left, as Christopher Boone and Sara Shippobotham as Voice One in Pioneer Theatre Company’s “The Curious Incident of the Dog in the Night-Time.” Brent Uberty

“I thought the way (Bryan) portrayed (Christopher) was pretty accurate based on my own patients and what I’ve experienced in my clinic,” said Michael Johnson, a neuroscience-imaging researcher and child and adolescent behavior health specialist at the University of Utah who is part of Xan Johnson’s research team. “So for people who don’t know autism, I thought the play did a great job for opening people’s eyes of how a person with autism tries to interface with the world.”

Xan Johnson’s area of academic interest is in social cognitive neuroscience as he understands it from the perspective of theater. He has spent his career using theater as an educational tool to help teens and elementary school-aged children. He and several of his other team members knew they wanted to do a study to see how participating in theater can train children with autism in life skills, but it was Michael Johnson who suggested they focus on preschool-aged children.

“If you intervene early and aggressively with lots of intervention earlier — as early as you can — then you increase probability that you’ve changed the longterm outcome of whatever the biology is that’s driving the autism,” Michael Johnson said. “There’s more brain cell plasticity that we might be able to take advantage of if we hit this early.”

The study will expose a group of children with autism and a group of typically developing children to drama therapy multiple times a week for several months. Along the way, evaluations will be done to see the effects of the therapy on the children. The therapy will be led by Penny Caywood, artistic director of Youth Theatre at the U.

“We did a feasibility study last summer … and now we’re ready to go; now we’re fired up,” Xan Johnson said. “We’re going to launch as soon as we find our population of at least five (autism spectrum disorder) 3 and 4-year-olds and three or four typically developing to be in our drama group.”

Many other types of intervention have been tested through the years to help children with autism with social skills, but Michael Johnson said the potential benefits offered by drama therapy are unique.

“I think the drama interventions have the potential to go beyond what more limited social skills groups do to bring the child more into the role of understanding others and taking on perspectives,” he said.

Harrison Bryan as Christopher Boone in Pioneer Theatre Company’s “The Curious Incident of the Dog in the Night-Time.” Brent Uberty

“There is a great dependency for individuals with autism on the skill of scripting,” Xan Johnson also explained. “Immediately when you say scripting, you think instantly of theater and scripts.”

Michael Johnson said he didn’t have any theater experience before he began working with Xan Johnson, but he’s seen how the study provides an opportunity for multiple disciplines to work together.

“It’s been part of this collaborative effort with how can we bring psychiatry, neuroscience and the humanities together,” he said. “The humanities have long sustained mankind in multiple ways through multiple centuries and millennia and we know that there’s healing potential.”

Both Xan and Michael Johnson said PTC’s “The Curious Incident of the Dog in the Night-Time” is an important play because it brings community awareness to what someone with autism experiences. According to the Center for Disease Control, autism affects 1 in 68 children in the United States.

“What we hope about using theater as an intervention to help preschoolers with autism better navigate a complex social world is the same hope we have for theater patrons attending (‘The Curious Incident’),” Xan Johnson said. “Such a transformational impact on theater patrons might change lives, and we hope the same is true for our preschoolers.”

The researchers are currently seeking preschool-aged participants for the study. For additional information, contact Megan Raby at 612-325-9802 or megan.raby@health.utah.edu.